Usage of a Web-Based Workplace and Symptom Self-Management Intervention Tool to Improve Work Ability for Breast Cancer Survivors.

This work aimed to evaluate the usage of a web-based intervention (WISE: Work ability Improvement through Symptom and Ergonomic strategies) developed to improve work ability for women recently diagnosed with breast cancer. Twenty-two women undergoing adjuvant treatment for breast cancer were provided access to WISE. This website includes content pages (e.g., information on ergonomics, symptom management, and other work-related resources) and worksheets (e.g., journals to track symptoms or goals). It could be personalized based on individual work activities and symptoms. Measures assessed at 3 months included usage of the website and perceived usefulness. Thirteen of the 22 participants (60%) accessed WISE; 11 personalized their information. Content and worksheet pages had 97 and 79 visits, respectively. Most frequently visited pages were "setting goals" (i.e., prioritize and track symptoms; 45 visits) and "steps to creating your WISE plan" (i.e., incorporate symptom and ergonomic strategies; 16 visits). Median duration time was 11.05 (range 0.35-79.55) minutes. Usefulness of the content and worksheet pages assessed via a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree) was 5.08 (SD = 1.59) and 4.26 (SD = 2.03), respectively. Participants were likely to recommend WISE to other women undergoing cancer treatment (mean = 6.11; SD = 1.05). The majority of participants personalized WISE work and symptom strategies. Overall, participants agreed that WISE content pages were useful and would recommend WISE for other breast cancer survivors. Results support that majority of breast cancer survivors, undergoing treatment with curative intent, accessed a web-based intervention that provided personalized information on workplace and symptom strategies.

Five-Year Program Evaluation of an Evidence-Based Practice Scholars Program.

The purpose of this article is to describe the findings of a 5-year program evaluation of a hospital-based Evidence-Based Practice (EBP) Scholars Program. The EBP Scholars Program was developed in 2011 to (a) educate and engage staff in the EBP process and (b) develop a cadre of EBP mentors within each clinical unit of the organization. The evaluation of the EBP Scholars Program examined both the feasibility and the impact of the program. The findings suggest that not only is the program feasible to implement and highly acceptable to the participants, but it also significantly increases staff EBP self-efficacy and promotes staff engagement in EBP, organizational leadership, and professional development. Most importantly, this program has been foundational to motivating and sustaining a strong culture of inquiry at our Magnet® designated organization. [J Contin Educ Nurs. 2018;49(12):547-554.].

Work-related barriers, facilitators, and strategies of breast cancer survivors working during curative treatment.

BACKGROUND: Research has identified barriers and facilitators affecting cancer survivors' return to work (RTW) following the end of active treatment (surgery, chemotherapy and/or radiation therapy). However, few studies have focused on barriers and facilitators that cancer survivors experience while working during active treatment. Strategies used by cancer survivors to solve work-related problems during active treatment are underexplored. OBJECTIVE: The aim of this study was to describe factors that impact, either positively or negatively, breast cancer survivors' work activities during active treatment. METHODS: Semi-structured, recorded interviews were conducted with 35 breast cancer survivors who worked during active treatment. Transcripts of interviews were analyzed using inductive content analysis to identify themes regarding work-related barriers, facilitators and strategies. RESULTS: Barriers identified included symptoms, emotional distress, appearance change, time constraints, work characteristics, unsupportive supervisors and coworkers, family issues and other illness. Facilitators included positive aspects of work, support outside of work, and coworker and supervisor support. Strategies included activities to improve health-related issues and changes to working conditions and tasks. CONCLUSIONS: Breast cancer survivors encounter various barriers during active treatment. Several facilitators and strategies can help survivors maintain productive work activities.

Nursing care of the super bariatric patient: challenges and lessons learned.

PURPOSE: The purpose of this article is to describe the care of a "super bariatric" patient. DESIGN AND METHODS: We used a case study approach to describe the complex interdisciplinary care challenges posed in the care of a super bariatric patient at a Veterans Administration Hospital in the Midwest. FINDINGS: Nurses and other healthcare providers discovered ways to provide high-quality patient-centered care under challenging conditions and also ensure the safety and well-being of nursing staff and other providers. CONCLUSIONS/CLINICAL RELEVANCE: An interdisciplinary, patient-centered approach with advance planning and coordination is necessary to ensure the delivery of safe, high-quality nursing care to veterans with complex health problems who are "super bariatric."

Relationships between three beliefs as barriers to symptom management and quality of life in older breast cancer survivors.

PURPOSE/OBJECTIVES: To describe relationships among perceived barriers to symptom management and quality of life and to test the mediating role of perceived communication difficulties on the relationships between other perceived barriers to symptom management and quality of life in older adult breast cancer survivors. DESIGN: Cross-sectional descriptive-correlational design using baseline data from a randomized, controlled trial that tested the efficacy and durability of the individualized representational intervention in reducing symptom distress and improving quality of life in older adult breast cancer survivors. SETTING: The community, an oncology clinic, and a state tumor registry. SAMPLE: 190 older adult breast cancer survivors (X age = 70.4 years) who were an average of 3.3 years after breast cancer diagnosis. METHODS: Path analysis using Mplus, version 5.1. MAIN RESEARCH VARIABLES: Negative beliefs about symptom management (Symptom Management Beliefs Questionnaire [SMBQ]), perceived negative attitudes from healthcare providers (Communication Attitudes [CommA]), perceived communication difficulties (CommD), and quality of life. FINDINGS: Significant direct effects of SMBQ and CommA on CommD were found after controlling for age, number of health problems, and number of symptoms. CommD was a significant mediator of the effects of CommA on quality of life after controlling for the covariates. SMBQ had significant total effects on quality of life after adjusting for the covariates but was not mediated by CommD. CONCLUSIONS: Patient-provider communication is an important factor in the quality of life of older adult breast cancer survivors. IMPLICATIONS FOR NURSING: Developing and testing nursing interventions focusing on enhancing both positive beliefs about symptom management and effective communication in old age is suggested. KNOWLEDGE TRANSLATION: Older adults and healthcare providers must overcome stereotyped beliefs about aging that may affect self-care and health outcomes for this population. Older adults must be allowed to express their views and emotions about aging.

Sexually transmitted disease testing misconceptions threaten the validity of self-reported testing history.

OBJECTIVE: Sexually transmitted disease (STD) testing is fundamental to STD prevention and control. We sought to comprehensively examine young women's beliefs about the STD testing process. DESIGN AND SAMPLE: Descriptive, cross-sectional, survey investigation. Women aged 18-24 (n = 302) drawn from four women's health clinics and one university classroom. MEASURES: Participants completed the RoTEST, which measures five domains of women's STD testing beliefs and a demographic survey. RESULTS: Many women believed they would be screened for all STDs when they receive STD testing (40%) and that visual inspection by a provider was a valid method of STD screening for gonorrhea (35%), chlamydia (32%) and HSV (77%). More than a quarter believed that a Pap test screens for gonorrhea (23%) and chlamydia (26%). Twenty-one percent reported that discussing STD testing with a provider is difficult and most reported feeling more comfortable seeking STD testing from an STD specialist rather than a family doctor (79%). CONCLUSIONS: Young women have numerous misconceptions about the STD testing process that may interfere with the validity of their self-reported STD testing history and subsequently undermine public health efforts to improve STD prevention and control. Innovative approaches to educating women about the testing process are needed.

Genital herpes beliefs: implications for sexual health.

STUDY OBJECTIVE: Genital herpes (HSV) is exceedingly common in the United States and women are disproportionally affected. This study aims to describe young women's beliefs about HSV and examine the correlates of those beliefs. DESIGN: A 40-item Herpes Representation measure (HSV-RoSTD) and a demographic questionnaire were administered to a convenience sample of young women. Data analysis included descriptive statistics, t-tests and Pearson's correlations. SETTING: Four women's health clinics and one large state university. PARTICIPANTS: 302 women aged 18-24 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Four dimensions of HSV representations (cause, identity, future perspective, and psychosocial consequences), age and STD testing history. RESULTS: Nearly all (98%) believed that HSV would result in genital sores and 68% believed they could tell if their sexual partner had HSV. Most (89%) understood the longevity of HSV; however, 30% believed that they could take a pill to get rid of the infection, and 15% indicated that it was likely they would die from HSV. Negative beliefs about the psychosocial impact of HSV were common as 95% indicated they would be depressed and 90% indicated concern about sex and partner notification. Those who were younger and those who had never been tested for STDs believed a genital herpes infection is highly symptomatic. Finally, negative beliefs about the psychosocial consequences of HSV were associated with beliefs about HSV being symptomatic, having a negative impact on future health, and being associated with sexual risk behaviors. CONCLUSIONS: Young women have misconceptions about HSV, particularly regarding the symptomatology and the role of HSV medication. Noteworthy concerns about the negative psychosocial consequences of an HSV diagnosis were also raised, all of which have implications for young women's sexual health.

Characterizing the psychological distress response before and after a cancer diagnosis.

Psychological distress among cancer survivors is common. It is unknown if symptoms predate diagnosis or differ from patients without cancer because studies are limited to patient follow-up. Linked cohort (Wisconsin Longitudinal Study) and tumor registry records were used to assess the psychological distress response pre- to post-cancer diagnosis. Adjusted predicted probabilities of being in one of five categories of change for three psychological distress measures (depression, anxiety, well-being) were compared for participants diagnosed with cancer between 1993-1994 and 2004-2005 and participants without cancer (N = 5,162). Cancer survivors were more likely to experience clinically significant increases (≥0.8 standard deviation) in depression (15, 95 % CI = 12-18 %) and anxiety (19 %, CI = 16-22 %) compared to their no-cancer counterparts (10 %, CI = 10-11 %; 11 %, CI = 11-12 %). Cancer survivors <5 years from diagnosis were more likely to experience worsening depression. Survivors ≥5 years were more likely to experience worsening anxiety. No significant results were found for well-being. Characterizing the psychological distress response is a prerequisite for identifying at-risk patients and communicating expected symptoms, allowing for proactive resource provision.

Caring for older adults with mild cognitive impairment: an update for nurses.

Mild cognitive impairment (MCI) is a mild decline in single or multiple cognitive domains, while global cognition and basic activities of daily living remain intact. Nurses play an important role in early detection of MCI and providing care to maintain maximum independence for individuals with MCI. This article seeks to provide nurses with a review of the most recent research regarding the etiology and diagnosis of MCI, related risk and protective factors, patient and family experiences, and current interventions. This update provides research evidence to inform nursing practice of MCI care.

Cancer screening of long-term cancer survivors.

BACKGROUND: Although 64% of cancer survivors are expected to live at least 5 years beyond diagnosis, the receipt of cancer screening by this population is unclear. The objective of this study was to assess the relation between a cancer diagnosis and future cancer screening, exploring provider-, patient-, and cancer-specific factors that explain observed relationships. METHODS: The Wisconsin Longitudinal Study (WLS) and Wisconsin Tumor Registry were used to identify 2 participant groups: 415 patients diagnosed with nonmetastatic cancer between 1992 to 1993 (before cancer) and 2003 to 2004 (after cancer) and 4680 controls (no cancer). Adjusted average predicted probabilities of cancer screening were estimated with models that first did not include and then included, provider (provider relationship length), participant (depressive symptoms per the Center for Epidemiologic Studies Depression Scale), and cancer-specific (time since diagnosis) factors. Participants with a history of cancer associated with a given screening test were then excluded to assess whether relationships are explained by screening for recurrence versus second cancers. RESULTS: Female cancer survivors were more likely than no-cancer controls to undergo pelvic/Papanicolaou screening (survivors: 70%, 95% confidence interval [CI]: 63% to 76%; controls: 61%, 95% CI: 59% to 63%) and mammography screening (survivors: 86%, 95% CI: 78% to 90%; controls: 76%, 95% CI: 74% to 77%), though male cancer survivors were not more likely to receive prostate exams (survivors: 76%, 95% CI: 70% to 82%; controls: 69%, 95% CI: 67% to 71%). After excluding people with a history of the cancer being screened for, there were few significant differences in cancer screening between short- or long-term survivors (≥5 years) and no-cancer controls. Relationships were not sensitive to adjustment for provider or participant factors. CONCLUSIONS: The significant positive differences in cancer screening between people with and without cancer can be explained by screening for recurrence. Long-term cancer survivors are not more likely to receive follow-up screening for second cancers. This information should be used by providers to ensure patients receive recommended follow-up preventive care.

Illness representations in older adults with mild cognitive impairment.

Little is known about patients' understanding of a diagnosis of mild cognitive impairment (MCI). The purpose of this cross-sectional descriptive study was to describe beliefs about MCI in people diagnosed with the condition and examine correlates (demographic and health) of those beliefs. Thirty individuals diagnosed with MCI completed the Illness Perception Questionnaire-MCI (IPQ-MCI), measuring eight domains of beliefs about MCI, and one scale of emotional distress. Five of them also participated in a 15-minute cognitive interview to explore responses to the IPQ-MCI. Participants correctly identified symptoms related to MCI; generally attributed MCI to aging, heredity, and abnormal brain changes; and believed MCI to be chronic, predictable, and controllable, causing little emotional distress. However, there were no consistent beliefs regarding the negative consequences of MCI or whether MCI was understandable. There were few significant correlates of beliefs. People with MCI are able to report their beliefs about their illness, suggesting that misconceptions and gaps in knowledge can be identified and addressed with nursing interventions.

Role of older adult's illness schemata in coping with mild cognitive impairment.

OBJECTIVE: 1) To describe the illness representations of older persons with Mild Cognitive Impairment (MCI); 2) to describe how older adults cope with MCI; 3) to examine the relationships between illness representations and coping. METHODS: Sixty-three older adults with MCI completed questionnaires on demographic and health information, beliefs about MCI (Illness Perception Questionnaire-MCI), and coping with MCI (brief COPE and Self-care Behaviors Checklist). RESULTS: Participants endorsed an average of 7 symptoms that they experienced and believed were related to MCI and an average of 7 potential causes of MCI. Participants tended to believe MCI was chronic, not cyclic, and controllable, but they differed in their beliefs about the consequences, understandability and emotional impact of MCI. Participants used many dementia prevention behaviors and memory aids, some problem-focused and emotion-focused coping strategies, and few dysfunctional coping strategies. Cluster analysis identified three clusters of beliefs about MCI: "few symptoms and positive beliefs," "moderate symptoms and positive beliefs," and "many symptoms and negative beliefs." Those in the "many symptoms and negative beliefs" cluster had significantly more negative beliefs about the consequences, unpredictability (cyclic timeline), and emotional impact of MCI than those in the other clusters. Participants in the "few symptoms and positive beliefs" cluster used significantly fewer memory aids, problem-focused coping strategies, emotion-focused coping strategies, and dysfunctional coping than those in the other two clusters. CONCLUSION: As suggested by the Common Sense Model, older adults with MCI have beliefs about their MCI and these beliefs are associated with how older adults cope with MCI.

Young women's Representations of Sexually Transmitted Diseases (RoSTD): a psychometric study.

Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding sexual health behaviors. The purpose of this study was to develop and test the psychometric properties of the Representations of STDs (RoSTD) Scale. The RoSTD was developed to measure young women's representations of STDs, and it is intended to be used to measure beliefs about any of the seven most common STDs. Confirmatory factor analysis indicated a four-factor structure for the 40-item RoSTD: Future Perspective, Cause, Psychosocial Consequence, and Identity. Internal consistency for the subscales (measured for each of seven different STDs) ranged from .67 to .93 and 2-week test-retest correlations ranged from .69 to .90. The RoSTD shows evidence of reliability and validity in young women.

Symptom clusters and quality of life in older adult breast cancer survivors.

PURPOSE/OBJECTIVES: To identify symptom clusters in older adult breast cancer survivors (ages 65-97 years) and examine whether symptom clusters are related to demographic, health, and quality-of-life variables. DESIGN: Factor analysis to identify possible symptom clusters. The resulting clusters then were correlated with quality-of-life measures. SETTING: Phone interviews between the participants and a trained research nurse. SAMPLE: 192 breast cancer survivors (X age = 70). METHODS: This was a secondary data analysis of the baseline measures of demographics, health history, symptom bother, and physical, mental, and existential dimensions of quality of life. Exploratory and confirmatory factor analyses were conducted as well as multiple indicator multiple cause modeling and partial correlation analyses to assess the relationships among clusters and demographic, health history, and quality-of-life measures. MAIN RESEARCH VARIABLES: Self-reported symptom bother, demographics such as age and education level, health history, and quality of life. FINDINGS: Seven clinically distinct symptom clusters tapping 36 different symptoms in older adult breast cancer survivors were found. These symptom clusters were significantly related to multiple dimensions of quality of life. CONCLUSIONS: Older adult breast cancer survivors experience multiple concurrent symptoms that appear to cluster. Identifying symptom clusters helps to elucidate possible intersymptom relationships which may lead to the design of more effective symptom management interventions for older adult breast cancer survivors. IMPLICATIONS FOR NURSING: Older adult breast cancer survivors should be assessed for a wide variety of symptoms if clinicians hope to identify and understand intersymptom relationships. Such assessment would enable more comprehensive symptom management.

Psychosocial predictors of changing sleep patterns in aging women: a multiple pathway approach.

The authors of this investigation sought to examine changes in the sleep quality of older women over time and to determine whether dimensions of psychological well-being, health (subjective health and number of illnesses), and psychological distress (depression and anxiety) predict these changes. A secondary analysis was conducted with a longitudinal sample of aging women (Kwan, Love, Ryff, & Essex, 2003). Of 518 community-dwelling older women in the parent study, 115 women (baseline M age = 67 years, SD = 7.18) with data at baseline, 8 years, and 10 years were used for this investigation. Participants completed self-administered questionnaires and participated in in-home interviews and observations. Growth curve modeling was used to examine the overall linear trajectories of sleep quality. Growth mixture modeling was used to examine whether there were different patterns of change in sleep quality over time and to examine baseline predictors of each pattern. Sleep quality declined over time but not for all women. Two distinctly different sleep patterns emerged: good but declining sleep quality and disrupted sleep quality. Higher psychological well-being (positive relations with others, environmental mastery, personal growth, purpose in life, and self-acceptance), fewer illnesses, and lower depression scores at baseline predicted reduced odds for membership in the disrupted sleep group. Future research is needed to examine whether interventions focused on maintaining or enhancing psychological well-being could minimize later life declines in sleep quality.

African American women's beliefs about mental illness, stigma, and preferred coping behaviors.

We examined African American women's representations/beliefs about mental illness, preferred coping behaviors if faced with mental illness, whether perceived stigma was associated with treatment-seeking, and if so, whether it was related to beliefs and coping preference, and whether these variables differed by age group. Participants were 185 community-dwelling African American women 25 to 85 years of age. Results indicated the women believed that mental illness is caused by several factors, including family-related stress and social stress due to racism, is cyclical, and has serious consequences but can be controlled by treatment. Participants endorsed low perceptions of stigma. Major preferred coping strategies included praying and seeking medical and mental health care. Age differences were found in all variables except stigma.

Older breast cancer survivors' symptom beliefs.

PURPOSE/OBJECTIVES: To use Leventhal's Common Sense Model (CSM) to describe older breast cancer survivors' symptom representations, symptom management strategies, and perceived barriers to symptom management. DESIGN: A secondary analysis was conducted using data from three pilot studies that tested a theory-based intervention to improve symptom management in older breast cancer survivors. SETTING: Advanced practice nurses conducted open-ended interviews with older breast cancer survivors either in their homes or via telephone. SAMPLE: Participants were recruited from the community, an oncology clinic, and a state tumor registry. The women (N = 61, X age = 69.5) were an average of 4.7 years after breast cancer diagnosis and reported an average of 17 symptoms. METHODS: Content analysis was conducted with field notes taken during baseline interviews. MAIN RESEARCH VARIABLES: Symptom representations, symptom management strategies, and perceived barriers to symptom management. FINDINGS: Women described their symptoms as chronic, incurable, and uncontrollable, with multiple causes (usually not aging) and numerous negative consequences. Women described an average of six symptom management strategies, most typically self-care. The most frequent barrier to symptom management was communicating with healthcare providers. CONCLUSIONS: The CSM is a useful framework for understanding the symptom beliefs of older breast cancer survivors. IMPLICATIONS FOR NURSING: Addressing women's beliefs and barriers may result in better communication with healthcare providers and more effective interventions for symptom management.

An individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors: three pilot studies.

PURPOSE/OBJECTIVES: To test the feasibility and acceptability of an individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors and test the short-term effects of an IRIS on symptom distress. DESIGN: Two small randomized clinical trials and one pre-experimental study. SETTING: Oncology clinic and community. SAMPLE: 41 women with breast cancer (aged 65 years and older) in pilot study 1, 20 in pilot study 2, and 21 in pilot study 3. METHODS: In pilot study 1, women were randomized to the IRIS or usual care control. In pilot study 2, women were randomized to the IRIS or delayed IRIS (wait list) control. In pilot study 3, all women received the IRIS by telephone. Measures were collected at baseline, postintervention, and follow-up (up to four months). MAIN RESEARCH VARIABLES: Feasibility, acceptability, symptom distress, symptom management behaviors, symptom management barriers, and quality of life. FINDINGS: Across three pilot studies, 76% of eligible women participated, 95% completed the study, 88% reported the study was helpful, and 91% were satisfied with the study. Some measures of symptom distress decreased significantly after the IRIS, but quality of life was stable. Women in the IRIS group changed their symptom management behaviors more than controls. CONCLUSIONS: Preliminary evidence supports the need for and feasibility of an IRIS. IMPLICATIONS FOR NURSING: Nurses may help older breast cancer survivors manage their numerous chronic symptoms more effectively by assessing women's beliefs about their symptoms and their current symptom management strategies.

Effect of perceived barriers to symptom management on quality of life in older breast cancer survivors.

Negative attitudes of both older adults and healthcare providers about aging can be barriers to self-care in old age. The aims of this study were to (1) examine the extent to which older breast cancer survivors experience barriers to symptom management and (2) explore whether barriers influence quality of life. Three possible barriers to symptom management were examined: negative beliefs about managing symptoms, perceived negative attitudes of healthcare providers, and difficulties in communicating about symptoms. This study was a secondary analysis of pooled baseline data from 61 older (age >64 years) women who participated in 2 pilot studies that tested a symptom management intervention for older breast cancer survivors. The most frequent barrier reported was difficulties in communicating about symptoms with healthcare providers. Each of the barriers affected psychosocial, but not physical, quality of life. Barriers to symptom management may lead to poorer self-care of symptoms that can result in lower levels of psychosocial quality of life. Healthcare providers need to encourage older cancer survivors to report symptoms and worries related to their cancer diagnosis and should be cautious in expressing attitudes that could reinforce older adults' negative perceptions about aging.

Intimate partner violence among pregnant Thai women.

The purposes of this study are to describe intimate partner violence (IPV) among pregnant women in Thailand and compare maternal characteristics, health practices during pregnancy, and maternal health between abused and nonabused pregnant women. Of 475 pregnant Thai women, 13.1% report ever being abused, whereas 4.8% report physical abuse during pregnancy. Women abused during pregnancy, compared to nonabused women, are more likely to be younger, unmarried, have low income, be unemployed, and report that the pregnancy was unwanted. They also report lower levels of positive health practices and higher levels of depressive symptoms. Results demonstrate a need for screening of IPV among pregnant Thai women.